Purpose
The purpose of this study was to evaluate the diagnostic performance of single-parameter,
unimodal and bimodal magnetic resonance imaging (MRI) in differentiating tumor recurrence
(TR) from radiation necrosis (RN) in patients with glioblastoma (GBM) after treatment
using diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), dynamic susceptibility
contrast enhancement-perfusion weighted imaging (DSC-PWI), and proton magnetic resonance
spectroscopy (1H-MRS).
Materials and Methods
Patients with histologically proven GBM who underwent surgical intervention followed
by chemoradiotherapy and developed a new, progressively enhanced lesion on follow-up
MRI were included in our study. Subsequently, DWI, DTI, DSC-PWI, and 1H-MRS were performed. Then, these patients underwent a second surgical operation or
follow-up MRI to prove TR or RN. MRI metrics include apparent diffusion coefficient
(ADC) and relative ADC (rADC) values derived from DWI; fractional anisotropy (FA),
axial diffusion coefficient (DA) and radial diffusion coefficient (DR) values derived
from DTI; and relative cerebral blood volume (rCBV) and relative cerebral blood flow
(rCBF) derived from DSC-PWI. Spectral metabolites such as choline (Cho), creatine
(Cr), N-acetylaspartate (NAA), lactate (Lac), and lipids (Lip) were derived from MRS,
and the ratios of these metabolites were calculated, including Cho/NAA, Cho/Cr, NAA/Cr,
Lac/Cr, and Lip/Cr. These indices were compared between the TR group and RN group,
and the receiver operating characteristic (ROC) curve was used to evaluate the performance
in distinguishing TR from RN by using single-parameter, unimodal and bimodal MRI.
Results
There were significant differences between the TR and RN groups in terms of ADC (p = 0.001), rADC (p < 0.001), FA (p = 0.001), DA (p = 0.003), DR (p = 0.003), rCBV (p < 0.001), rCBF (p < 0.001), Cho/NAA (p < 0.001), Lac/Cr (p < 0.001) and Lip/Cr (p < 0.001). ROC analysis suggested that rCBV, MRS, and DSC + MRS were the optimal single-parameter,
unimodal, and bimodal MRI classifiers for distinguishing TR from RN, with AUC values
of 0.909, 0.940, and 0.994, respectively.
Conclusion
The combination of parameters based on multiparametric MRI in the region of enhanced
lesions is a valuable noninvasive tool for discriminating TR from RN.
Key Words
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REFERENCES
- A Phase 2 Study of Concurrent Radiation Therapy, Temozolomide, and the Histone Deacetylase Inhibitor Valproic Acid for Patients With Glioblastoma.Int J Radiat Oncol Biol Phys. 2015; 92: 986-992
- A three-dimensional (3D) organotypic microfluidic model for glioma stem cells - Vascular interactions.Biomaterials. 2019; 198: 63-77
- Integrated genomic analysis identifies clinically relevant subtypes of glioblastoma characterized by abnormalities in PDGFRA, IDH1, EGFR, and NF1.Cancer Cell. 2010; 17: 98-110
- Congress of neurological surgeons systematic review and evidence-based clinical practice parameter guidelines for the treatment of adults with newly diagnosed glioblastoma: Introduction and Methods.J Neurooncol. 2020; 150: 87-93
- Incorporating diffusion- and perfusion-weighted MRI into a radiomics model improves diagnostic performance for pseudoprogression in glioblastoma patients.Neuro Oncol. 2019; 21: 404-414
- Cerebral radiation necrosis: incidence, pathogenesis, diagnostic challenges, and future opportunities.Curr Oncol Rep. 2019; 21: 66
- Diffusion magnetic resonance imaging: an early surrogate marker of therapeutic efficacy in brain tumors.J Natl Cancer Inst. 2000; 92: 2029-2036
- Peritumoral brain regions in gliomas and meningiomas: investigation with isotropic diffusion-weighted MR imaging and diffusion-tensor MR imaging.Radiology. 2004; 232: 451-460
- Prospective comparative diagnostic accuracy evaluation of dynamic contrast-enhanced (DCE) vs. dynamic susceptibility contrast (DSC) MR perfusion in differentiating tumor recurrence from radiation necrosis in treated high-grade gliomas.J Magn Reson Imaging. 2019; 50: 573-582
- Glioma residual or recurrence versus radiation necrosis: accuracy of pentavalent technetium-99m-dimercaptosuccinic acid [Tc-99m (V) DMSA] brain SPECT compared to proton magnetic resonance spectroscopy (1H-MRS): initial results.J Neurooncol. 2012; 106: 579-587
- Diagnostic Performance of PET and Perfusion-Weighted Imaging in Differentiating Tumor Recurrence or Progression from Radiation Necrosis in Posttreatment Gliomas: A Review of Literature.AJNR Am J Neuroradiol. 2020; 41: 1550-1557
- Improving the utility of (1)H-MRS for the differentiation of glioma recurrence from radiation necrosis.J Neurooncol. 2017; 133: 97-105
- Advanced MRI increases the diagnostic accuracy of recurrent glioblastoma: Single institution thresholds and validation of MR spectroscopy and diffusion weighted MR imaging.Neuroimage Clin. 2016; 11: 316-321
- Comparison of three different MR perfusion techniques and MR spectroscopy for multiparametric assessment in distinguishing recurrent high-grade gliomas from stable disease.Acad Radiol. 2013; 20: 1557-1565
- Differentiation of true progression from pseudoprogression in glioblastoma treated with radiation therapy and concomitant temozolomide: comparison study of standard and high-b-value diffusion-weighted imaging.Radiology. 2013; 269: 831-840
- Evaluation of radiation necrosis and malignant glioma in rat models using diffusion tensor MR imaging.J Neurooncol. 2012; 107: 51-60
- 123I-IMT SPECT and 1H MR-spectroscopy at 3.0 T in the differential diagnosis of recurrent or residual gliomas: a comparative study.J Neurooncol. 2004; 70: 49-58
- Diffusion-weighted imaging in the follow-up of treated high-grade gliomas: tumor recurrence versus radiation injury.AJNR Am J Neuroradiol. 2004; 25: 201-209
- Role of FDG-PET/MRI, FDG-PET/CT, and Dynamic Susceptibility Contrast Perfusion MRI in Differentiating Radiation Necrosis from Tumor Recurrence in Glioblastomas.J Neuroimaging. 2018; 28: 118-125
- Comparison of dynamic susceptibility-weighted contrast-enhanced MR methods: recommendations for measuring relative cerebral blood volume in brain tumors.Radiology. 2008; 249: 601-613
- Multiparametric MRI for Differentiation of Radiation Necrosis From Recurrent Tumor in Patients With Treated Glioblastoma.AJR Am J Roentgenol. 2018; 210: 18-23
- Toward distinguishing recurrent tumor from radiation necrosis: DWI and MTC in a Gamma Knife–irradiated mouse glioma model.Int J Radiat Oncol Biol Phys. 2014; 90: 446-453
- Diffusion-weighted MR imaging for the differentiation of true progression from pseudoprogression following concomitant radiotherapy with temozolomide in patients with newly diagnosed high-grade gliomas.Acad Radiol. 2012; 19: 1353-1361
- Axial diffusivity and tensor shape as early markers to assess cerebral white matter damage caused by brain tumors using quantitative diffusion tensor tractography.CNS Neurosci Ther. 2012; 18: 667-673
- Detection of glioblastoma subclinical recurrence using serial diffusion tensor imaging.Cancers (Basel). 2020; 12
- Assessment of diffusion tensor imaging metrics in differentiating low-grade from high-grade gliomas.Neuroradiol J. 2016; 29: 400-407
- Differentiation of residual/recurrent gliomas from postradiation necrosis with arterial spin labeling and diffusion tensor magnetic resonance imaging-derived metrics.Neuroradiology. 2018; 60: 169-177
- Comparison of diffusion tensor, dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain SPECT for the detection of recurrent high-grade glioma.Magn Reson Imaging. 2014; 32: 854-859
- Diffusion tensor imaging for understanding brain development in early life.Annu Rev Psychol. 2015; 66: 853-876
- Comparison of Diffusion Tensor Imaging and Magnetic Resonance Perfusion Imaging in Differentiating Recurrent Brain Neoplasm From Radiation Necrosis.Acad Radiol. 2016; 23: 569-576
- Combination of IVIM-DWI and 3D-ASL for differentiating true progression from pseudoprogression of Glioblastoma multiforme after concurrent chemoradiotherapy: study protocol of a prospective diagnostic trial.BMC Med Imaging. 2017; 17: 10
- Glioblastoma treated with concurrent radiation therapy and temozolomide chemotherapy: differentiation of true progression from pseudoprogression with quantitative dynamic contrast-enhanced MR imaging.Radiology. 2015; 274: 830-840
- Differentiating radiation necrosis from tumor progression in brain metastases treated with stereotactic radiotherapy: utility of intravoxel incoherent motion perfusion MRI and correlation with histopathology.J Neurooncol. 2017; 134: 433-441
- Clinical applications of proton MR spectroscopy.AJNR Am J Neuroradiol. 1996; 17: 1-15
- The relationship between Cho/NAA and glioma metabolism: implementation for margin delineation of cerebral gliomas.Acta Neurochir (Wien). 2012; 154 (discussion 1370): 1361-1370
- Distinction between recurrent glioma and radiation injury using magnetic resonance spectroscopy in combination with diffusion-weighted imaging.Int J Radiat Oncol Biol Phys. 2007; 68: 151-158
- The Molecular Effects of Ionizing Radiations on Brain Cells: Radiation Necrosis vs. Tumor Recurrence.Diagnostics (Basel). 2019; 9
- Diagnosis of glioma recurrence using multiparametric dynamic 18F-fluoroethyl-tyrosine PET-MRI.Eur J Radiol. 2018; 103: 32-37
Article Info
Publication History
Published online: December 09, 2021
Accepted:
November 10,
2021
Received in revised form:
November 6,
2021
Received:
September 21,
2021
Identification
Copyright
© 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
